Dry pleurisy symptoms treatment with folk remedies. Exudative (effusion) pleurisy: features, signs, treatment

Exudative pleurisy is a pathology in which inflammation of the pleural layer of the lungs occurs with the accumulation of fluid in the costophrenic sinus. Nonspecific pathogens rarely provoke nosology, since the body has reliable local and general defense systems against them.

Exudation is detected by auscultation (when listening with a phonendoscope) and on a chest x-ray.

Exudative pleurisy: causes

The most common cause of exudative pleurisy is tuberculosis infection. When the pleural layers are damaged, the mycobacterium forms inflammatory changes gradually. Only with a strong decrease in immunity does the microorganism gain the opportunity for active reproduction.

Exudation may be a consequence of fibrinous changes, when a chronic infection “dorms” in fibrin threads.

To detect exudative fluid on an x-ray, its amount must exceed 200 ml. With a large amount of exudate in the pleural cavity, breathing difficulties are created, as the liquid compresses the lungs.

In practice, the tumor nature of pleurisy is sometimes encountered. The accumulation of exudate makes it difficult to visualize the tumor. Only pleural puncture allows you to open the visible part of the lung tissue where the tumor is localized.

Symptoms of exudative pleurisy

The main symptom of exudative pleurisy is pain in the lungs and hypochondrium. With fibrinous inflammation of the lungs, the pain syndrome is not expressed. Exudate does not accumulate in the pleural cavity. The only symptom of the disease is shortness of breath. Impaired respiratory function causes hypoventilation of the pulmonary field.

With exudative pleurisy, auscultatory symptoms are observed:

Dullness of pulmonary sound in the projection of the location of the fluid;
Breathing is weakened in the lower part of the lungs;
Above the location of the exudate, bronchial breathing is heard.

The severity of the manifestations of the disease depends on the rate of accumulation of effusion, volume, and severity of the underlying inflammation. With intense accumulation of fluid, pain occurs. As exudate accumulates, the leaves become wetted, which reduces the severity of pain. When you try to press on the intercostal spaces above the location of the inflammatory focus, acute pain occurs due to irritation of the nerve receptors.

Increasing respiratory failure leads to shortness of breath and reflex cough.

Upon external examination of the patient, the forced position on the sore side is striking. Pallor of the skin, cyanosis of the face, decreased blood pressure, and tachycardia appear.

Lung diseases, despite the achievements of modern medicine, are still extremely common. The reason is the deterioration of the environmental situation. Atmospheric pollution from hazardous industrial waste and vehicle exhaust gases leads to breathing problems. Smoking, bacteria, viruses and malignant tumors play an important role. All these diverse harmful factors can lead to a special pulmonary disease - exudative pleurisy.

The role of the lungs in the development of exudative pleurisy

The lungs do all the work of providing the body with oxygen. For greater reliability, nature has created two identical organs, each of which is able to cope with its responsibilities alone. The lungs consist of two fundamentally different parts - the bronchial and alveolar trees. The bronchi are a system of tubes of different diameters through which air enters the lungs. There is no gas exchange between air and blood in this area. For this purpose, oxygen needs to enter the alveoli. These are small spherical structures that connect with the smallest bronchus into an integral system. The alveoli are densely entangled on all sides with a network of small vessels - pulmonary capillaries. It is here, at the border of the alveoli and the vascular walls, that oxygen enters the systemic bloodstream.

The lung consists of the bronchial and alveolar trees

Each lung contains ten full-fledged segments containing a large bronchus, a network of smaller ones and many alveoli. Gas exchange occurs in each segment. Twenty virtually identical structural units determine the fantastic strength of the entire respiratory system. Failure of even half of the segments will not allow the body to suffer significant losses in oxygen supply. The main protector of the lungs is a frame of twelve pairs of ribs and a strong outer membrane - the pleura. It covers the outside of the lungs (visceral pleura) and the inside of the chest (parietal pleura). Between these layers there is a small free space - the pleural cavity. Normally, there is a small amount of fluid present here. It helps the lungs move within the pleural cavity to allow inhalation and exhalation.

Pleural cavity - a small space between the visceral and parietal pleura

Exudative - inflammation of the visceral and parietal pleura, which leads to excess fluid accumulation. This disease is by no means extremely rare. A million cases of this disease are registered annually in the world among adults and children. As a rule, pleurisy is not a completely independent diagnosis. There are certainly other pathologies associated with it.

With exudative pleurisy, fluid accumulates in the pleural cavity

Pleurisy - video

Classification

Exudative pleurisy is a heterogeneous disease. Based on a number of signs, several forms of this pathology can be distinguished.

Based on the cause of inflammation, the disease is divided into two types:
- infectious pleurisy. The starting point of the disease is the entry of microbes into the pleural cavity;
- aseptic pleurisy. In this case, the cause of inflammation is the patient’s own immune system, which aggressively affects the alveoli, bronchi and pleura.
Microbes that most often cause pleurisy:
According to the nature of inflammation of the pleura, they are distinguished:
According to the type of course, the forms of the disease are distinguished:
- acute pleurisy is characterized by vivid symptoms and rapid accumulation of fluid;
- Chronic pleurisy has a long course, the fluid may periodically disappear under the influence of treatment and then accumulate again.

Causes and development factors

Common to any type of exudative pleurisy is inflammation of the pleura, consisting of connective tissue. The trigger is most often an infection. Microbes appear in the pleural cavity through the bloodstream or penetrate there directly from the lungs. The body's immune system sends white blood cells to fight infection. They populate the pleura in large numbers and slow down the blood flow in it. Gradually, the liquid portion of the blood begins to leak out of the vessels and fill the small slit-like space between the parietal and visceral pleura. Most often, inflammation in this scenario is caused by the tuberculosis bacillus. As its habitat, it chooses areas of the lung directly adjacent to the pleura.

Pulmonary tuberculosis in the later stages is characterized by pleurisy and the formation of cavities (cavities)

Tuberculosis - video

The lungs are often affected by immune diseases. For some unknown reason, white blood cells tend to the areas of the lung lying between the bronchi and alveoli. There is a special connective tissue here, which becomes a target for immune aggression. Along with these areas, the pleura, a large mass of connective tissue, also suffers.

Immune disease often affects the pleura and connective tissue of the lungs

Any pathological area in the lung quickly becomes the cause of inflammation of the pleura and fluid accumulation. In this way, the body tries to stop the spread of the disease. The pathological site may be a focus of inflammation or a malignant tumor of the bronchi and alveoli. The tumor can grow in another organ - ovary, kidney, stomach. The cause of pleurisy is metastasis - a secondary focus of a malignant neoplasm.

Metastasis - a secondary focus of malignant tumor growth

Lung cancer - video

Symptoms and signs

Exudative pleurisy can be asymptomatic for a long time. The slow accumulation of fluid makes the disease invisible. Signs of pleurisy are often masked by symptoms of the underlying disease.

Symptoms of exudative pleurisy - table

Methods for diagnosing pleurisy

Diagnosis of exudative pleurisy is a task for an experienced specialist. To determine the nature of the disease and the amount of accumulated fluid, a high-quality, comprehensive examination is necessary. Laboratory tests and instrumental methods play an important role:

An external examination will help the doctor identify some indirect signs of pleurisy - changes in the shape of the chest, cyanosis of the skin and mucous membranes. Auscultation of the lungs (listening) is a method that has been used since time immemorial. Under normal conditions, using a simple phonendoscope above the lungs, you can hear the clearly audible sound of alveoli expanding as you inhale. The fluid in the pleural cavity greatly muffles this sound. This feature is easily detected by a specialist;
A blood test is a standard diagnostic method that must be performed regardless of the suspected diagnosis. Inflammation characteristically changes the composition of the blood: the number of white blood cells, leukocytes, and (the rate of sedimentation of red blood cells of erythrocytes to the bottom of the test tube) increases;
The lungs and pleura are the most suitable objects in the body for examination using radiography. Dense ribs and air in the lungs create excellent light contrast. Against this background, inflammatory foci and tumors are well diagnosed. The accumulation of liquid in the image appears dense and completely obscures other details. Due to its anatomical features, the fluid level in the pleural cavity appears oblique rather than horizontal in the image. By the location of this line, you can approximately estimate the amount of fluid in the pleural cavity.
Radiography is the main method for diagnosing exudative pleurisy
tomography is a method for more detailed diagnosis of lung anatomy. CT uses X-rays to create images, MRI uses nuclear magnetic resonance. Images taken at different levels make it possible to identify foci of pneumonia, tumors, and tuberculous changes. In addition, CT and MRI make it possible to accurately assess the amount of fluid accumulated in the pleural cavity;
Tomography is a method for detailed diagnosis of pleurisy
To diagnose the nature of pleurisy, fluid taken with a syringe through a puncture of the chest wall (pleural puncture) is examined. Studying the material is carried out in several ways. The detection of protein and leukocytes proves the inflammatory nature of the fluid. Under a microscope, a specialist will detect microbes and malignant tumor cells. To determine the specific type of pathogenic bacterium, the liquid is placed on a nutrient medium and maintained at body temperature. Grown bacteria are studied under a microscope and using biochemical tests, which makes it possible to determine their specific species;
Pleural puncture - a diagnostic measure for exudative pleurisy
Thoracoscopy is a modern method for diagnosing pulmonary diseases. A miniature video camera is inserted into the pleural cavity through a puncture, which allows for examination of the visceral and parietal pleura. During the procedure, a section of the pleura and lung is removed with a special instrument. The resulting material, after preparation and staining, is examined under a microscope. It is histology that often determines the final diagnosis;
Thoracoscopy is a modern, low-traumatic research method
if the infectious nature of pleurisy is suspected, the blood is examined for the presence of specific antibody proteins using enzyme immunoassay and polymerase chain reaction.

Polymerase chain reaction - video

Treatment methods

Therapy for exudative pleurisy is carried out by an experienced specialist. Establishing an accurate diagnosis and selecting medications requires hospitalization. After discharge, therapy continues, in some cases for life. Treatment of exudative pleurisy is usually complex, aimed at eliminating the cause of the disease, inflammation of the pleura and accumulated fluid.

Medicines for the treatment of pleurisy

Pleurisy is a reason to prescribe medications. Currently, there is a large selection of drugs that can effectively fight infection, inflammation, malignant tumors, and immune reactions.

Drugs for the treatment of pleurisy - table

Pharmacological group	Examples of drugs	Diseases in which medications are used
Antibiotics	Isoniazid; Ceftriaxone; Augmentin.	tuberculosis; pneumonia.
Anti-inflammatory drugs	Ibuprofen; Nise; Celecoxib.	tuberculosis; pneumonia;
Steroid hormones	Hydrocortisone; Dexamethasone.	systemic inflammation of connective tissue; operations on the chest.
Cytostatics	Azathioprine; Cisplatin; Doxorubicin.	malignant tumors; metastases in the lungs; systemic inflammation of connective tissue.
Diuretics	Veroshpiron; Furosemide; Diuver; Trigrim.	Heart failure

Drugs for the treatment of exudative pleurisy - photo gallery

Rifampin - a drug for the treatment of tuberculosis Clarithromycin is prescribed for nonspecific exudative pleurisy Meloxicam belongs to the group of non-steroidal anti-inflammatory drugs Prednisolone has a powerful anti-inflammatory effect Methotrexate is an antitumor drug Lasix is an effective diuretic drug

Surgical treatment of exudative pleurisy

In some cases, drug treatment of pleurisy must be combined with surgery. The help of a surgeon is necessary in the following cases:

Physiotherapy

Physiotherapy successfully complements the complex treatment of exudative pleurisy. To eliminate fluid, the following types of procedures are prescribed:

Diet

For exudative pleurisy, it is recommended to adjust the diet. An increase in protein and vitamins allows the body to quickly cope with the disease and increase its overall resistance to infections and other harmful factors. It is advisable to take food in several doses (5-6 times a day). All cooking methods are acceptable. It is recommended to consume the following products:

bread made from wheat and rye flour;
meat of various varieties;
sea and river fish;
dairy and fermented milk products;
vegetable and meat soups;
side dish of rice and buckwheat;
berry desserts;
fresh juices;
cottage cheese and cheese.

Wheat bread contains B vitamins Meat is a source of protein Fermented milk products contain calcium Vegetable soup is the perfect first course Freshly squeezed juice contains vitamin C

If possible, you should exclude the following foods from your diet:

confectionery with cream;
cooking fat;
fatty varieties of pork and lamb;
carbonated drinks;
alcohol;
strong coffee and tea.

Confectionery products with cream are not recommended It is not recommended to eat fatty meats Alcohol negatively affects the lungs Strong tea contains a lot of caffeine Strong coffee causes heart palpitations and increased blood pressure

Exudative pleurisy is a serious disease, so treatment with folk remedies is not recommended.

Complications and prognosis

The prognosis for therapy for exudative pleurisy is extremely individual and depends on the nature of the disease. Pneumonia can be cured with antibiotics. With a successful combination of circumstances, the manifestations of tuberculosis can be reduced to nothing. The tumor in its initial stages is amenable to surgical treatment. Chronic diseases cannot be completely eliminated, but timely treatment makes it possible to transfer the disease to the stage of inactive manifestations. The most serious complication of exudative pleurisy is respiratory failure.

Prevention

Prevention of pleurisy includes the following measures:

Exudative pleurisy is a serious disease. Finding a definitive diagnosis can take time. Treatment for the disease often requires lifelong treatment. However, timely contact with a specialist will significantly increase the chances of a favorable outcome.

Treatment of pleurisy with traditional methods

Greetings, dear readers of the blog Narmedblog.ru. Autumn has come to us, winter is coming soon. The cold season contributes to the occurrence of widespread colds, ranging from a common runny nose to dangerous flu and pneumonia. The topic of today's article is the treatment of pleurisy using traditional methods.

Causes of pleurisy and its symptoms

● Our lungs are covered on all sides with a special membrane called pleura. This shell protects them: they slide freely along the chest when breathing. During inflammatory processes, the pleura thickens and swells, becoming uneven - thus pleurisy occurs.

● Pleurisy itself, as a rule, is recorded very rarely: with massive hypothermia or trauma in the chest area. In most cases, pleurisy is a companion to some other pulmonary disease: tuberculosis, pneumonia, bronchitis. Somewhat less frequently, it develops as a complication of diseases of the abdominal organs: pancreatitis or hepatitis.

● In medicine, two types of pleurisy are distinguished: dry and effusion (or exudative) - with the release of fluid into the pleural cavity.

● With dry pleurisy, there is no fluid in the pleural cavity; the pleural layers rub against each other when breathing, causing acute pain in the chest, especially when coughing. You can often hear from a patient with pleurisy: “My chest hurts so much, it’s as if someone was stabbing with an awl.” He has to take a forced position in order to calm the pain at least a little: he lies on the healthy side of the chest or leans against some object.

● With dry pleurisy, body temperature rises, often reaching 38-38.5 degrees. Appetite decreases, the patient loses weight.

● When fluid accumulates in the pleural cavity, the volume of which can reach up to five liters, the pain subsides, a wet cough appears instead of a dry one, and noticeable shortness of breath begins. Breathing is bubbling - heard at a distance, it is superficial, irregular, and often whistling. This condition is accompanied by weakness, chills and profuse sweat.
How to differentiate pleurisy from other pulmonary diseases

● To make a diagnosis, clinical observations alone are not enough - the results of laboratory blood tests and x-ray examination of the chest organs are needed. The presence of a serious inflammatory process in the body is indicated by anemia (anemia), leukocytosis (increased number of white blood cells), an increase in ESR (erythrocyte sedimentation rate) to 70-80 units.

● A fairly reliable method for diagnosing pleurisy is chest X-ray, but it has the following disadvantage: it can detect darkening in the pleural cavity only when the volume of pleural fluid in the pleural cavity is at least 300−500 ml. That is, an x-ray will not show the presence of dry pleurisy.

● There is another way to clarify the diagnosis - puncture of the pleural cavity. Using this method, the doctor sends pleural fluid for laboratory testing and subsequently determines both the degree of the inflammatory process and the cause of the disease based on its quantity, color, consistency, and the presence of microbial flora.

“Attention: only a certified doctor can establish an accurate diagnosis and prescribe treatment for you, so I strongly recommend that you agree with your doctor on all the recommendations given below.”

Treatment of pleurisy - the first stage

● Do not delay the illness, contact your local doctor. Self-medication can cause a compressed lung to stop functioning completely. Treatment of pleurisy should be comprehensive. First of all, you need to stop the main process that led to the occurrence of pleurisy.

● Subsequently, antibiotics and anti-inflammatory drugs are prescribed. Among the antibiotics, the most effective are clindamycin, fortum, cefobid, and cefatoxime. The course of treatment lasts 2-3 weeks, after which, if necessary, you can replace antibiotics with sumamed, augmentin, amoxilav.

● Depending on the severity of the disease, treatment of pleurisy lasts up to two months, and is strictly individual for each patient. Along with antibiotics, the doctor prescribes non-steroidal anti-inflammatory drugs: voltaren or ibuprofen; in especially severe cases, people with weakened immune systems are prescribed a hormonal medicine - prednisolone.

● In case of dry pleurisy, if there is no high temperature (fever), the patient is prescribed distractive medications: alcohol warming wraps (compresses), mustard plasters, cups on the chest area.
Treatment of pleurisy with traditional methods

● Many medicinal herbal mixtures effectively affect the inflammatory process in the lungs, but in the treatment of pleurisy they are prescribed in combination with pharmaceutical drugs, and during the period of convalescence (recovery). For diseases of the upper respiratory tract, licorice root, white willow bark, fennel fruits, linden blossom, plantain grass, hyssop, knotweed, and coltsfoot leaves have proven themselves to be effective as an expectorant and anti-inflammatory agent.

● Recipe No. 1. Pour two tablespoons of chopped fennel fruits with a glass of boiling water and place in a water bath for 15-20 minutes. Let it brew for one hour. Take ⅓ glass of decoction three times a day for dry pleurisy.

● Recipe No. 2 - for exudative (effusion) pleurisy. Pour 50 grams of linden blossom and two tablespoons of birch buds into two glasses of boiled water; heat the medicinal mixture in a water bath for 15 minutes and then leave for one hour. Strain the broth and add one glass of linden honey and aloe juice to it, place again in a water bath for five minutes. Stir and add one glass of vegetable oil (preferably olive). Take one tablespoon before meals three times a day for one month.

● Recipe No. 3 - for the treatment of dry and exudative pleurisy. Grind and mix equal proportions of coltsfoot leaves, black elderberry flowers and knotweed grass. Pour one tablespoon of the mixture into 200 ml. boiling water and leave in a thermos for half an hour. Drink ¼ glass of infusion half an hour before meals three or four times a day.
General treatment and preventive measures for pleurisy

● A patient with pleurisy after prolonged use of antibiotics becomes weak, his immune activity decreases. He urgently needs to restore his lost strength. The diet should be high-calorie, balanced, rich in vitamins and minerals. In order not to provoke a cough, it is better to avoid spicy foods.

● With exudative pleurisy, water-salt metabolism in the body is disrupted, so it is recommended to limit salt intake to 5 grams, as well as liquid to 1 liter per day.

● During the period of convalescence, you should walk in the fresh air more often, do morning exercises and feasible physical activity. This significantly improves blood circulation, prevents the formation of adhesions in the pleural area, relieves painful shortness of breath, that is, it gradually returns you to your previous normal active and fulfilling life.

Be healthy and may God bless you!!!

Exudative or effusion pleurisy is a pathology of the respiratory system in which a large amount of fluid (exudate) accumulates in the pleural cavity, the symptoms are clear, treatment is conservative and surgical (puncture and drainage). Normally, the space between the two layers of pleura contains only a few milliliters of fluid, which allows the pleura to slide. The fluid is produced and absorbed at a certain speed, but under the influence of pathologies, the production of exudate increases, and its removal from the pleural cavity slows down.

In the vast majority of cases, effusion pleurisy is not an independent disease, but a symptom of another pathology. But occasionally primary pleurisy is also diagnosed.

Classification of exudative pleurisy

Effusion can be classified according to various criteria:

According to the etiology of the disease: infectious, aseptic.
According to the course of the pathological process: acute, subacute, chronic.
According to the composition of the effusion: serous, hemorrhagic, serous-fibrinous, eosinophilic, purulent, putrefactive, cholesterol, chylous, mixed.
According to the location of the effusion: free, encysted (limited by adhesions between the layers of the pleura).

In this case, encysted forms can be subdivided depending on where exactly the localization of the accumulation of exudate is located: apical, parietal, diaphragmatic, bone-diaphragmatic, paramediastinal, interlobar.

Also, pleurisy can affect the pleura of both lungs (bilateral) or only one (right-sided, left-sided).

Development mechanism

Normally, between the layers of the pleura there is no more than 10 ml of liquid, but during effusion its amount can reach 4 liters, and even exceed this figure.

This occurs due to the following pathological processes:

increased permeability of vascular walls;
increased intravascular pressure;
decrease in the barrier function of the visceral pleura;
reduction of the effusion-absorbing function of the parietal pleura.

As a result, fluid accumulates in the pleural cavity, and its removal through the capillaries and lymphatic vessels does not occur. Filling of the pleural cavity with fluid leads to compression of the lungs (or one lung, if pleurisy is unilateral) and disruption of the respiratory process.

Causes

The etiology of exudative pleurisy can be different. More often, the cause of the syndrome is the entry of infectious agents (bacteria, viruses, fungi) into the pleural cavity. Infectious pleurisy can also be caused by tuberculosis (up to 80% of all cases), pneumonia, or lung abscess.

Aseptic pleurisy develops against the background of various diseases, both lungs and other body systems, which include allergic reactions and autoimmune systemic diseases. There is a category of post-traumatic effusion pleurisy, as well as pneumothorax due to oncological tumors.

Infectious causes

Infectious exudative pleurisy complicates inflammatory processes:

pneumonia – microbial inflammation of the respiratory tissue of the lungs;
abscess - a source of suppuration of the lung;
gangrene - infectious destruction of the lung;
tuberculosis of the lungs.

The cause of infectious exudative pleurisy is the penetration of pathogens of the underlying disease into the pleural cavity. Microbes get there from a site of decay or inflammation located close to the outer shell of the organ. The infection can also travel through lymphatic capillaries and blood vessels.

The cause of exudative pleurisy of tuberculosis etiology is an avalanche-like increase in the sensitivity of the patient’s body to the tuberculosis bacillus (sensitization). The result of sensitization is the rapid accumulation of reactive effusion when even single microbes enter the pleura. Tuberculous exudative pleurisy affects mainly adult patients.

The accumulation of effusion in the chest cavity for non-inflammatory or unknown reasons is called “hydrothorax” or non-infectious (aseptic) effusion pleurisy.

Non-infectious causes

chest injury with hemorrhage into the pleural cavity;
pulmonary infarction due to blockage of the pulmonary artery by a thrombus - a blood clot;
malignant tumors of the pleura and lungs (carcinomatosis, mesothelioma, cancer);
chronic circulatory failure;
chronic renal failure;
autoimmune connective tissue diseases (rheumatism, collagenosis);
malignant blood tumors;
liver cirrhosis provokes right-sided exudative pleurisy;
inflammation of the pancreas causes reactive left-sided effusion pleurisy.

Symptoms of exudative pleurisy

The clinical picture of the disease depends on its severity, the type of exudate, and the amount of accumulated effusion.

Some of the more common symptoms include:

shortness of breath;
chest pain;
inability to take a deep breath;
cough;
general weakness, loss of appetite;
periodically rising temperature.

With purulent effusion, the disease is more severe, with fever and symptoms of intoxication. The clinical picture is also influenced by the fact of which lung is affected: left-sided pleural effusion provokes symptoms from the heart muscle, for example, arrhythmia, an increase in heart rate to 120 beats per minute.

Phases of disease development

The pathology progresses over three stages:

accumulation of exudate in the pleural cavity;
stabilization of the condition, when the amount of effusion does not increase or decrease;
resorption of exudate.

Each stage can last up to 3 weeks.

X-ray signs

A radiological symptom of exudative pleurisy is massive shading of the pulmonary field in the lower sections. In contrast to pneumonic shadowing, the X-ray shadow of pleural effusion has an obliquely ascending border.

Diagnostics

Diagnosis begins with examining the patient and collecting anamnesis. Among the characteristic signs are pale skin, shallow breathing, the desire to lie on one side in a certain position if pleurisy is one-sided. During the act of breathing, the affected part of the chest lags behind; during percussion (tapping), the sound is dull; when listening to the lungs with a stethoscope, bursts are heard.

After this, the patient is sent for functional and laboratory diagnostics:

X-rays of light;
thoracentesis – removal of part of the pleural effusion for examination;
Ultrasound of the pleural cavity;
CT scan of the lungs;
thoracoscopy – endoscopic examination of the pleural cavity through a puncture of the chest;
biochemical and general blood test.

The most accurate and therefore mandatory research methods are x-rays and thoracentesis.

Treatment of exudative pleurisy

Treatment of exudative pleurisy is carried out in accordance with the underlying disease, usually includes evacuation of the effusion and elimination of the cause of the pathology with the help of medications.

Infectious processes complicated by pleural effusion are treated with antibiotics.

If there is a significant accumulation of fluid in the chest cavity, it is removed through a puncture in the chest wall (and pleural cavity). The resulting effusion is sent to the laboratory. Test results help determine the cause of pleurisy and choose the necessary treatment.

A modern method for diagnosing and treating exudative pleurisy is videothoracoscopy. The endoscopic device is inserted into the pleural cavity through a small puncture in the chest wall. The surgeon examines the chest cavity from the inside, takes samples of effusion and pieces of pleura for analysis, and performs therapeutic measures.

Pleural puncture

Pleural puncture is a method of removing exudate from the pleural cavity using a puncture. When excess fluid is eliminated, the lung expands and the person instantly feels relief. The procedure is performed under local anesthesia, the effusion is removed slowly, and the resulting fluid is sent to the laboratory for testing.

Through a needle, after draining the pleural cavity, drugs can be injected into the pleural cavity: antiseptics, antibiotics, hormonal and antitumor agents, depending on the diagnosis.

Drug therapy

Medicines are prescribed depending on the diagnosis:

for tuberculosis - tuberculostatic drugs;
for pneumonia - antibiotics;
in oncology - cytostatics;
for autoimmune pathologies, allergies - glucocorticoids, etc.

Medications may also be prescribed for symptomatic treatment to quickly relieve the patient’s well-being: antitussives, analgesics, antispasmodics, diuretics.

Physiotherapy

Physiotherapy helps speed up the healing process and is therefore used in conjunction with drug treatment and drainage of the pleural cavity. For effusion, chest massage, electrophoresis, paraffin therapy, and breathing exercises are effective.

Physiotherapy, like other methods of therapy, is prescribed by the attending physician.

Prevention

Prevention of exudative pleurisy is a set of recommendations for a healthy lifestyle and timely consultation with a doctor:

to give up smoking;
climatotherapy with sea air;
hardening of the body;
proper treatment of any infections, refusal of self-medication;
regular fluorography (once a year).

If you have already had the disease, an x-ray should be taken 6 months after recovery.

The arrow in the image indicates exudate.

Exudative pleurisy is usually called an inflammatory process in the lining of the lungs - the pleura, which is accompanied by the formation of pleural effusion. Pleural effusion is the accumulation of excess fluid in the lining of the lungs. In exudative pleurisy, this fluid is called exudate. This type of pleurisy can also be called effusion. He may continue to have dry pleurisy.

In a healthy state, a person has a small amount of serous fluid in the pleural cavity, which prevents excessive friction between the layers of the membrane of the lungs during the act of breathing. However, the amount of fluid in the pleural cavity during effusion pleurisy is many times higher than normal.

Also, exudate differs from normal serous fluid in its composition, which can be different, depending on the primary disease, the complication of which was pleurisy. Treatment should combine effects on both the inflammatory process in the lining of the lungs and the root cause of this process.

When and why does effusion pleurisy occur?

Exudative pleurisy accompanies a number of diseases of infectious and non-infectious origin and has its own symptoms that complement the picture of the underlying disease, the clinical picture of which is often more vivid. The most common underlying diseases are:

The reason for the formation of exudate is a violation of microcirculation - blood circulation in the smallest vessels, which does not allow the inner layer of the lining of the lungs to absorb excess fluid secreted by the outer layer into the pleural cavity. In addition, absorption is also hindered by the substance fibrin that quickly covers the surface of the pleural layers.

How to recognize the disease

Diagnosis and differential diagnosis of the exudative form of the disease is based on the clinical picture: the clinic includes not only general, but also symptoms characteristic of effusion pleurisy, as well as laboratory and instrumental methods chosen by the doctor during the diagnostic search.
Most often, exudative pleurisy does not have such striking symptoms as severe pain in the dry form of the disease, for example. It is characterized by a rise in the patient's body temperature to 37-38 degrees, accompanied by chills, increased sweating, weakness, lethargy and drowsiness of the patient, which are caused by intoxication, that is, the release of toxic products into the blood. On the affected side, the patient usually experiences a feeling of heaviness, which occurs due to compression of the lung tissue by exudate. For example, exudative pleurisy on the left will give symptoms of discomfort and heaviness in the left half of the chest, and on the right – in the right. Later, when the effusion becomes quite large, the patient shows signs of respiratory failure: he can no longer breathe normally, he develops symptoms of shortness of breath and the inability to perform physical activity due to difficulty inhaling. Sometimes a strong reflex dry cough may occur. A dry cough is caused by displacement of the trachea and damage to the pleura itself, which is rich in various nerve endings.

A more detailed examination of the patient will reveal new symptoms of the disease. Upon examination, you will notice that the patient tends to take a semi-sitting position and slightly tilt the body to the painful side, and sometimes lies down on the healthy side. This allows you to increase the respiratory movements of a healthy lung and the flow of oxygen into the body through it, somewhat alleviating the suffering of the patient.

Since the patient’s body does not receive enough oxygen, his skin may take on a grayish or even bluish tint. These symptoms are called cyanosis. The half of the chest in which the exudate is located is usually visually slightly larger than the healthy one. It also lags behind the second half of the chest in terms of the speed of respiratory movements.

If you percussion, that is, start tapping the chest, then over the area where the effusion is located, a dull sound will be heard, unlike the sound over healthy lung tissue.

An important point is that the formation of a large amount of exudate, more than 4 liters, can lead to displacement of the mediastinum - the heart with the surrounding anatomical formations, which will also give characteristic symptoms. For example, a left-sided process will cause the mediastinum to shift to the right if the process is combined with pneumonia, that is, it is infectious. If the inflammatory process in the lining of the lungs during pneumonia is on the right, then the clinic will reveal a shift of the mediastinum to the left.

To the left, with a left-sided lesion, the mediastinum will shift when the effusion is caused by a tumor process and is combined with collapse of the lung tissue on the affected side. In addition, exudative pleurisy on the left can be recognized by the disappearance of a ringing, so-called tympanic sound, if the surface of the abdomen to the left of the navel is percussed immediately below the costal arch. Also, exudative pleurisy on the left will result in weakening, and more often the absence of respiratory noise in the projection of fluid in the pleural cavity on the left. Such signs and symptoms make it possible to diagnose mediastinal displacement with almost complete certainty.

Dry pleurisy will not cause displacement of the mediastinum, since with it the inflammatory process in the pleura is not accompanied by exudation.

Laboratory diagnosis of effusion pleurisy is based mainly on a blood test. An increase in the number of white blood cells - leukocytes, which take part in inflammatory reactions - will be detected in the blood. The erythrocyte sedimentation rate will also be increased. A biochemical blood test will reflect the appearance of inflammatory protein compounds, such as C-reactive protein, for example.

Instrumental diagnosis of the exudative form of pleural inflammation includes a number of techniques. The simplest, but quite informative of them is chest radiography.

X-ray, light area – location of exudate.

Using an x-ray, you can determine the presence of effusion and its approximate level, that is, get an approximate idea of the amount of exudate.

If there is little inflammatory fluid in the pleural cavity, that is, its amount does not exceed 150-200 ml, the so-called laterography method is used to clarify its presence.

The image shows the relative position of the patient with the X-ray machine during laterography.

The latter consists of conducting an X-ray examination with the patient positioned on the affected side. If there is an inflammatory exudate, then a narrow ribbon-like shadow will be visible on the x-ray.

In the lower part of the image there is a darkening (light area) - this is a strip of exudate.

Such diagnostics reduces the frequency of errors that often fill the medical history.

Diagnosis of effusion pleurisy must necessarily include examination of the effusion itself, the evacuation of which is ensured by thoracentesis, that is, puncture of the pleural cavity.

Thoracentesis is a puncture, that is, a puncture, of the pleural cavity with subsequent removal of the exudate accumulated there.

Correct position of the patient and injection site.

This makes it possible to alleviate the patient’s condition by straightening previously compressed lung tissue, and also makes it possible to examine the inflammatory fluid from the pleural cavity.

Puncture technique.

Fluid should be removed slowly during puncture to avoid a sharp drop in the patient's blood pressure.

The surgical procedure may be complicated by the following phenomena:

Bleeding.
Pneumothorax is the entry of air into the pleural cavity, which requires urgent measures to remove it, the first of which is drainage of the pleural cavity.
Infection.
Damage to nearby organs.
A sharp drop in blood pressure in a patient.

When the puncture is performed and fluid is obtained from the pleural cavity, it is necessary to make sure that it is exudate. The fluid may be a so-called transudate - a non-inflammatory effusion that is formed due to changes in the physical properties of blood in the pulmonary vessels, usually due to heart failure or renal failure. Transudate is a clear, yellowish liquid that is usually odorless.

Always, if an effusion is recognized as an exudate, its bacteriological examination should be carried out in order to identify the infectious nature of the disease and correctly select antibacterial treatment in accordance with the causative microorganisms isolated from the effusion.

Differential diagnosis for the exudative form of inflammation of the lining of the lungs should be carried out in two directions. Firstly, the actual confirmation of damage to the lining of the lungs, which is usually possible with a clinic that includes signs of the disease. Secondly, different root causes are characterized by different physical states of the exudate, as well as its composition. The description of all differential diagnostic measures should include a medical history.

Therapeutic measures

Treatment of patients with exudative pleurisy should combine a drug component with a non-drug component, as well as careful nursing care for the patient.

Non-drug treatment boils down to activating the patient and improving the blood supply to the lung tissue. For him, nursing supervision is usually sufficient. Tapping on the chest, movements from side to side, right to left and left to right, in bed are carried out, that is, all kinds of obstruction of the patient’s constant static position.

Drug treatment for effusion pleurisy is quite varied:

It is important to note that in both dry and effusion forms of pleurisy, both nursing and medical supervision of the patient should be carried out with the utmost care. The medical history should record all manipulations performed on the patient. It is especially important that the medical history includes information about thoracentesis, since the latter can have quite serious complications.